An evidence-based guide to the efficacy and safety of isometric resistance training in hypertension and clinical implications.

More than 30 randomized controlled trials, supported by individual patient-level and group-level meta-analyses and a Delphi analysis of expert opinion, unequivocally show isometric resistance training (IRT) elicits antihypertensive benefits in healthy people and those with chronic illness. We aim to provide efficacy and safety evidence, and a guide for IRT prescription and delivery. Recommendations are made for the use of IRT in specific patient populations and appropriate methods for IRT delivery. Published data suggest IRT consistently elicits mean blood pressure reductions of 7.4/3.3 mmHg systolic blood pressure/diastolic blood pressure, equivalent to antihypertensive medication monotherapy. Blood pressure reductions of this size are associated with an approximate 13% to 22% reduction in major cardiovascular events. Moreover, IRT is safe in a range of patient populations. We suggest that IRT has the greatest potential benefit when used as an antihypertensive therapy in individuals unwilling and/or unable to complete aerobic exercise, or who have had limited adherence or success with it; individuals with resistant or uncontrolled hypertension, already taking at least two pharmacological antihypertensive agents; and healthy or clinical populations, as an adjunct to aerobic exercise and dietary intervention in those who have not yet attained control of their hypertension. IRT is efficacious and produces clinically meaningful blood pressure reductions (systolic blood pressure, 7 mmHg; diastolic blood pressure, 3 mmHg). IRT is safe and typical program delivery requires only about 17 min weekly. IRT should be used as an adjunct to other exercise modalities, in people unable to complete other types of exercise, or in resistant hypertension. [Abstract copyright: © 2023. The Author(s).

An evidence-based guide to the efficacy and safety of isometric resistance training in hypertension and clinical implications

More than 30 randomized controlled trials, supported by individual patient-level and group-level meta-analyses and a Delphi analysis of expert opinion, unequivocally show isometric resistance training (IRT) elicits antihypertensive benefits in healthy people and those with chronic illness. We aim to provide efficacy and safety evidence, and a guide for IRT prescription and delivery. Recommendations are made for the use of IRT in specific patient populations and appropriate methods for IRT delivery. Published data suggest IRT consistently elicits mean blood pressure reductions of 7.4/3.3 mmHg systolic blood pressure/diastolic blood pressure, equivalent to antihypertensive medication monotherapy. Blood pressure reductions of this size are associated with an approximate 13% to 22% reduction in major cardiovascular events. Moreover, IRT is safe in a range of patient populations. We suggest that IRT has the greatest potential benefit when used as an antihypertensive therapy in individuals unwilling and/or unable to complete aerobic exercise, or who have had limited adherence or success with it; individuals with resistant or uncontrolled hypertension, already taking at least two pharmacological antihypertensive agents; and healthy or clinical populations, as an adjunct to aerobic exercise and dietary intervention in those who have not yet attained control of their hypertension. IRT is efficacious and produces clinically meaningful blood pressure reductions (systolic blood pressure, 7 mmHg; diastolic blood pressure, 3 mmHg). IRT is safe and typical program delivery requires only about 17 min weekly. IRT should be used as an adjunct to other exercise modalities, in people unable to complete other types of exercise, or in resistant hypertension

Lipid profile, cardiorespiratory function and quality of life of postmenopausal women improves with aerobic exercise

Objective: Menopause is characterized by physiological changes with increased risk of obesity, dyslipidemia and decreased quality of life (QoL). Despite the plethora of reports on the alleviating effect of exercise on climacteric symptoms, there is little documentation of this lifestyle intervention among Ghanaian menopausal women. This study examined the effect of aerobic exercise on lipid profile, cardiorespiratory function and QoL among menopausal women. Methods: Eighteen sedentary postmenopausal women between 45 to 75 years were randomly assigned to experimental (EG, n=8) and control (CG, n=10) groups. The EG received moderate intensity aerobic exercise training for eight weeks, three times a week while the CG observed normal daily activities. Blood pressure, resting heart rate, BMI, and lipid profile were measured and QoL assessed using the Utian QoL questionnaire at weeks 0 and 9. Results: After 8 weeks, the EG demonstrated significant decrease in cardiovascular risk ratio by 6.5L% and a non-significant decrease in LDL by 11.9L%. The CG showed significant increase in systolic BP by 3.2%L and a non-significant increase in LDL and cardiovascular risk by 14.9L% and 9.4L% respectively. QoL significantly improved in the EG group compared to CG after the 8 weeks. Conclusion: The health and QoL of participants in EG was significantly better than the CG at the end of the experiment. Aerobic exercise decreases cardiovascular disease risk in postmenopausal women and shows potential impact on lipid profile and health QoL. Proactively sponsored aerobic exercise programmes geared towards healthy living of postmenopausal women in Kumasi, Ghana are recommended

Isometric Resistance Training and Remote Ischaemic Conditioning as Adjunct Therapies for Hypertension

BackgroundHypertension remains a cardiovascular disease (CVD) risk factor and is the leading cause of morbidity and mortality globally. Maintaining optimal blood pressure (BP) is important for CVD prevention and treatment. Recommended hypertension treatment includes both pharmacological and non-pharmacological interventions. Non-pharmacological interventions, or lifestyle modifications, such as exercise training, have varied approaches and long-term adherence is challenging. A growing interest in non-pharmacologic approaches necessitates alternative anti-hypertensive interventions. In this thesis the primary aim was to evaluate isometric resistance training (IRT) and remote ischaemic conditioning (RIC) as potential adjunct therapies for hypertension. Methods Systematic reviews and meta-analyses were undertaken to evaluate 1) the benefits and risks of intensive versus standard BP treatment targets in older adults with hypertension; 2) the effect of exercise training on the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system (SNS) activity as these relate to BP changes; 3) the efficacy of IRT for hypertension management; and 4) the magnitude of RIC effects on BP. A modified Delphi technique was employed to seek expert opinion on the safety, efficacy, programming, delivery and mechanisms of action of IRT as an adjunct anti-hypertensive therapy. Finally, findings from these works were used to outline an evidence-based guide on the efficacy, safety and delivery of IRT. Results The major findings from the systematic reviews and meta-analyses demonstrated that 1) Lower BP treatment targets significantly reduced the relative risk of major cardiovascular events and all-cause mortality; 2) Exercise training produced significant reductions in BP, mediated via changed angiotensin-II and aldosterone concentrations, both key mediators of RAAS; 3) IRT significantly lowered both office and night-time ambulatory BP; and 4) Repeated, but not acute, RIC produced clinically meaningful reductions in BP. The Delphi analysis showed expert consensus for the efficacy of IRT as an anti-hypertensive therapy, but some concerns remained regarding safety and optimal delivery of leg IRT. Conclusion This thesis identified IRT and RIC as simple and cost-effective anti-hypertensive therapies that can be achieved with minimal commitment. Repeat RIC seems promising, especially for unconditioned people who are unable to complete exercise training. The limited number studies evaluating RIC for hypertension management, however, tempered the recommendation of RIC as an adjunct anti-hypertensive therapy. The findings confirmed IRT as a potential adjunct anti- hypertensive therapy; IRT may produce similar effects to one antihypertensive medication and can be used as an alternative for those who cannot perform conventional exercise training. The evidence-based guide substantiated this and provides practical guidance on prescription and delivery of IRT

Safety, efficacy and delivery of isometric resistance training as an adjunct therapy for blood pressure control: a modified Delphi study

Uncontrolled hypertension remains the major risk factor for cardiovascular disease. Isometric resistance training (IRT) has been shown to be a useful nonpharmacological therapy for reducing blood pressure (BP); however, some exercise physiologists and other health professionals are uncertain of the efficacy and safety of IRT. Experts' consensus was sought in light of the current variability of IRT use as an adjunct treatment for hypertension. An expert consensus-building analysis (Delphi study) was conducted on items relevant to the safety, efficacy and delivery of IRT. The study consisted of 3 phases: (1) identification of items and expert participants for inclusion; (2) a two-round modified Delphi exercise involving expert panelists to build consensus; and (3) a study team consensus meeting for a final item review. A list of 50 items was generated, and 42 international experts were invited to join the Delphi panel. Thirteen and 10 experts completed Delphi Rounds 1 and 2, respectively, reaching consensus on 26 items in Round 1 and 10 items in Round 2. The study team consensus meeting conducted a final item review and considered the remaining 14 items for the content list. A final list of 43 items regarding IRT reached expert consensus: 7/10 items on safety, 11/11 items on efficacy, 10/12 items on programming, 8/10 items on delivery, and 7/7 on the mechanism of action. This study highlights that while experts reached a consensus that IRT is efficacious as an antihypertensive therapy, some still have safety concerns, and there is also ongoing conjecture regarding optimal delivery

The effect of remote ischaemic conditioning on blood pressure response: A systematic review and meta-analysis

Background: Previous work has evaluated the effect of remote ischaemic conditioning (RIC) in a number of clinical conditions (e.g. cardiac surgery and acute kidney injury), but only one analysis has examined blood pressure (BP) changes. While individual studies have reported the effects of acute bouts and repeated RIC exposure on resting BP, efficacy is equivocal. We conducted a systematic review and meta-analysis to evaluate the effects of acute and repeat RIC on BP. Methods: A systematic search was performed using PubMed, Web of Science, EMBASE, and Cochrane Library of Controlled Trials up until October 31, 2020. Additionally, manual searches of reference lists were performed. Studies that compared BP responses after exposing participants to either an acute bout or repeated cycles of RIC with a minimum one-week intervention period were considered. Results: Eighteen studies were included in this systematic review, ten examined acute effects while eight investigated repeat effects of RIC. Mean differences (MD) for outcome measures from acute RIC studies were: systolic BP 0.18 mmHg (95%CI -0.95, 1.31; p = 0.76), diastolic BP -0.43 mmHg (95%CI -2.36, 1.50; p = 0.66), MAP -1.73 mmHg (95%CI -3.11, −0.34; p = 0.01) and HR -1.15 bpm (95%CI -2.92, 0.62; p = 0.20). Only MAP was significantly reduced. Repeat RIC exposure showed non-significant change in systolic BP -3.23 mmHg (95%CI -6.57, 0.11; p = 0.06) and HR -0.16 bpm (95%CI -7.08, 6.77; p = 0.96) while diastolic BP -2.94 mmHg (95%CI -4.08, −1.79; p p Conclusions: Our data suggests repeated, but not acute, RIC produced clinically meaningful reductions in diastolic BP and MAP

Blood pressure control in older adults with hypertension: A systematic review with meta-analysis and meta-regression

Background: Managing blood pressure reduces CVD risk, but optimal treatment thresholds remain unclear as it is a balancing act to avoid hypotension-related adverse events. Objectives: This systematic review, meta-analysis and meta-regression evaluated the benefits of intensive BP treatment in hypertensive older adults. Methods: We systematically searched PubMed, MEDLINE, EMBASE, and the Cochrane Library of Controlled Trials until January 31, 2020. Studies comparing different BP treatments/targets and/or active BP against placebo treatment, with a minimum 12months follow-up, were included. Risk ratios (RR) and 95% CIs were calculated using a random effects model. The primary outcome was RR of major cardiovascular events (MCEs); secondary outcomes included myocardial infarction (MI), stroke, heart failure (HF), cardiovascular (CV) mortality, and all-cause mortality. Results: We included 16 studies totaling 65,890 hypertensive participants (average age 69.4years) with a follow-up period from 1.8 to 4.9 years. Intensive BP treatment significantly reduced the relative risk of MCEs by 26% (RR:0.74, 95%CI 0.64–0.86, p=0.000; I²=79.71%). RR of MI significantly reduced by 13% (RR:0.87, 95%CI 0.76–1.00, p=0.052; I²=0.00%), stroke by 28% (RR:0.72, 95%CI 0.64–0.82, p=0.000; I²=32.45%), HF by 47% (RR:0.53, 95% CI 0.43–0.66, p=0.000; I²=1.23%), and CV mortality by 24% (RR:0.76, 95%CI 0.66–0.89, p=0.000; I²=39.74%). All-cause mortality reduced by 17% (RR:0.83, 95%CI 0.73–0.93, p=0.001; I²=53.09%). Of the participants - 61% reached BP targets and 5% withdrew; with 1 hypotension-related event per 780 people treated. Conclusions: Lower BP treatment targets are optimal for CV protection, effective, well-tolerated and safe, and support the latest hypertension guidelines